Provider Demographics
NPI:1326036369
Name:KESSLER, JEFFREY R (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:KESSLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4062 FRAGILE SAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5022
Mailing Address - Country:US
Mailing Address - Phone:410-465-5311
Mailing Address - Fax:410-838-6681
Practice Address - Street 1:530 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4330
Practice Address - Country:US
Practice Address - Phone:410-879-1105
Practice Address - Fax:410-838-6681
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
211328OtherMAMSI OPT CHOICE
453046OtherAETNA
54730701OtherBCBS
211328OtherMAMSI OPT CHOICE
54730701OtherBCBS